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Managing Our Meds
September 14, 2006 • Volume 6, Issue 37Over half of adults aged 65 and older fail to comply with their medication regimens, often because they suffer from dementia. Trouble sticking to medication regimens often leads to one-quarter of nursing home admissions. Medication-related problems are a leading cause of both hospitalization and death among older adults and add $200 billion each year to the U.S. health care bill.
The statistics paint a grim picture but, across the country, pharmacists have initiated promising programs that have helped older adults stay on course with their drug therapies and have uncovered and corrected medication errors. Geriatric pharmacists have been able to prompt doctors to change prescriptions that exacerbate dementia or inappropriately treat dementia-related behaviors with powerful antipsychotic drugs.
These initiatives all fall under the developing practice of medication therapy management. All Part D plans are required by law to establish medication therapy management programs.
But for too many Part D plans, medication therapy management involves little more than mailing educational brochures to plan members with specific diseases, techniques that are useless in reaching people with dementia. Most rely exclusively on internal staff and outreach over the phone, rather than employing community-based pharmacists or doctors to engage in one-on-one, face-to-face counseling.
Through that type of personal interaction the doctor or pharmacist can understand the full spectrum of medicines an individual is taking, including drugs not covered by Part D (such as over-the-counter drugs), and the effect those medicines are having on the individual. Such community-based interventions can include family members who can provide crucial information on how a loved one reacts to particular drugs and can help maintain compliance with a drug regimen.
Although the Centers for Medicare & Medicaid Services (CMS) has said medication therapy management should become a “cornerstone” of the prescription drug benefit, it has imposed no minimum standards on these programs. As a result Part D plans have set up minimal programs, and the potential of medication therapy management to improve the lives and health of millions of people with Medicare may never be realized.
Part D plans are poorly suited to deliver medication therapy management programs. Plans maximize profits when they hold down prescription drug costs, but medication therapy management can raise drug costs as well as lower them. Good programs can reduce hospitalization or admission to nursing homes and save Medicare money, but none of those savings benefits the Part D stand-alone plans.
To realize its full potential, medication therapy management, like prescription drug coverage itself, should be a benefit under Original Medicare. That is a fundamental reform that Congress needs to take up. In the meantime, there is much that CMS can do, through Original Medicare and through the Part D plans, to pilot community-based medication therapy management programs. People with Medicare, in particular those suffering from dementia, deserve it.
For those in the Washington, DC, area: MRC invites you to attend a presentation Friday, September 15, on medication therapy management. Details can be found here.
Medical Record
“CMS should take an active role in promoting pilot projects that would allow ‘best practices’ to emerge. The anemic state of most existing Part D MTM [medication therapy management] programs argues for a more proactive approach. Through its demonstration authority, in conjunction with the Part D plans and separately under Part B, CMS should allow a range of providers to pilot MTM programs that will provide lessons in both the delivery of MTM services and the clinical protocols that should underlie them. Pilot programs targeting individuals with Alzheimer’s and other forms of dementia should be a major part of this effort” (“Making Medication Therapy Management a Cornerstone of Community-Based Care for People with Alzheimer’s Disease and Other Forms of Dementia,” Medicare Rights Center, September 2006).
“Medications are probably the single most important technology in preventing illness, disability, and death in the senior population. Appropriate use of a medication saves more than it costs in terms of reduced overall health care expenditures, lower incidence of disease, and greater productivity and functionality. However, if not properly dispensed and monitored medicines can hurt instead of help” (“Seniors at Risk: Designing the System to Protect America’s Most Vulnerable Citizens from Medication-Related Problems,” American Society of Consultant Pharmacists, March 2004).
“Services offered by MTM [medication therapy management] programs should be delivered by an interdisciplinary MTM team led by a qualified pharmacist or other health care professional; team members should have expertise in the specifics of the medications in question. The inclusion of different perspectives will often highlight problems that may be unforeseen when only the prescriber and patient are involved. Ineffective use of medications is a multifactorial problem. Effective MTM programs address these factors as well as the root causes of suboptimal use of medications and the fundamental changes that will be necessary” (“Sound Medication Therapy Management Programs 2006 Consensus Document,” Academy of Managed Care Pharmacy, 2006).
***** The Medicare Rights Center (MRC) needs to hear about all the problems with the Medicare Part D benefit, whether they happen to you or someone in your community. With this information, we will be armed with the needed evidence to push for a Medicare-administered drug benefit.
Fast Relief: Part D Monitoring Project
Submit your story at www.medicarerights.org/partdstories.html
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